May 29, 2019

Proposed LCDs on PVA for Osteoporotic VCF Released for Public Comment

As a result of a recent multi-jurisdictional Contractor Advisory Committee (CAC) meeting, two proposed Local Coverage Determination (LCD) policies will be released to the public for review and comment. Two Medicare Administrative Contractors (MACs) will allow the public to weigh in on these proposed policies for 45 days. The final LCD, along with responses to comments, will be published after the comment period on the Medicare Contractor Database with a notice period of 45 days before the LCD is effective. In addition, the MACs will host open meetings to present the proposed LCDs including evidence and rationale of decisions. In addition to physicians, other health professionals (e.g., nurses, social workers and epidemiologists) and Medicare beneficiaries can participate in these meetings. We encourage the interventional radiology (IR) community to engage in these proposed LCDs. With the evolution of the new LCD process and CAC structure subject matter experts are able to weigh in on Medicare coverage.

Noridian Healthcare Solutions, LLC

Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF) (DL34228)

Public comment period: June 4, 2019 – July 19, 2019

Open meeting:
June 4, 2019
2:00 – 3:00 PM ET
Registration Link

National Government Services, Inc.

Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF) – will be posted June 6, 2019

Public comment period: June 27, 2019 – August 10, 2019

Open meeting:
June 27, 2019
1:00 – 2:30 PM ET
Registration Link

Background

 MACs hosted its first multi-jurisdictional CAC meeting on March 20, 2019. The purpose of the meeting is to obtain advice from CAC members and SMEs regarding the strength of published evidence on PVA for osteoporotic VCF. Ever since two high-profile, methodologically controversial, randomized control trials found no benefit of percutaneous vertebroplasty over the sham in 2009, there has been a lack of consensus on the appropriate management of osteoporotic VCF, particularly the role of PVA. After several recent publications further question the value of PVA, Contractor Medical Directors (CMDs) thought it was appropriate to reassess current Medicare coverage. CAC panels do not make coverage determinations, but MACs benefit from their advice. A Contractor Medical Director workgroup was formed to review such evidence, and each of the 7 MACs participated in the meeting. Radiology played an instrumental role in the meeting. Special thanks to Joshua A. Hirsch MD, FACR, FSIR, FSNIS, for being selected to moderate the call alongside NGS Medical Director Craig Haug. The Society for Interventional Radiology along with CAC representatives across five states were instrumental in reviewing and voting on the strength of published evidence. A transcript of the meeting is now available.

ACR staff and CAC network representatives will continue to monitor progress made on proposed policies related to radiology. Questions or comments related to proposed LCDs may be directed to Alicia Blakey at ablakey@acr.org.